Quality care is critical to protecting and improving the health and well-being of our customers. With the help of our behavioral health quality committee, Evernorth^® Behavioral Health (Evernorth) maintains standards for service and quality behavioral care. For 2023, we are pleased to report significant clinical and service improvements. They are outlined below.

IMPROVEMENTS FROM 2022 TO 2023

Network and service growth

In 2023, the behavioral provider network grew from 266,042 to 284,694 (+7%). There were also significant increases in contracted services for:

• Telehealth………………………………. +23.0%
• Autism specialty………………………. +12.6%
• Emergency responder specialty….. +15.0%
• Prescribers……………………………… +11.0%
• Master’s level therapists……………. +  7.4%

Improvements in HEDIS^®* measures

Improvements in other measures

Other achievements

• Evernorth delegation audit score: 96.8%.
• Inter-Reviewer Reliability Exercises: Goal met.
• Provider satisfaction survey updates provided additional details on coordination of care (and potential barriers to coordination).
• State compliance, mental health parity, and health equity workgroups: Improved partnering.
• Data analytics: Improved resources.
• Year-to-date admissions per 1,000 and days per 1000: Favorable for all levels and types of care.
• Quality, utilization management, and case management: Continued collaborative processes.
• Social determinants of health, population health management, and health equity: Continued reporting development.
• Quality improvement complaint workgroup: Continued to address turnaround times.
• Quality improvement workgroup: Continued to address low turnaround times for retrospective denials.
• Case management satisfaction survey: Results met goal.
• Well Informed gaps-in-care rates: Improvements made.
• Provider directory accuracy and geo-availability studies: All goals met.

2024 opportunities and recommendations

Continue improvements for:

• Achievement of NCQA Managed Behavioral Health Organization reaccreditation.
• Clinical HEDIS rates and other clinical measures.
• Utilization of HEDIS proactive data to identify opportunities for improvement in real time.
• Ongoing updates to and expansion of Well Informed gaps-in-care measures.
• Expand use of the behavioral predictive model metrics.
• Complaint resolution timeliness.
• Retrospective denial timeliness.
• Claims turnaround time.
• Utilization management and denial resolution timeliness.
• Appointment access.
• Assessment and dedication of resources to enhance and improve the effectiveness of our services to meet the needs of our customers.

Continue to integrate:

• Website tools and resources on the Evernorth provider website (Provider.Evernorth.com).
• Relevant initiatives with medical partners.

Additional information

For more information about the Evernorth Behavioral Quality and Utilization Management program, call Provider Services at 800.926.2273. We welcome your feedback and suggestions for improvement to our program.

If you have any questions or to share feedback, please contact Provider Services at 800.926.2273.

*    Healthcare Effectiveness Data and Information Set (HEDIS) us a registered trademark of the National Committee for Quality Assurance (NCQA).

**   Morphine milligram equivalent.